Undescended Testicle: Difference between revisions
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* '''Surgical correction is offered early after diagnosis''' | * '''Surgical correction is offered early after diagnosis''' | ||
* '''<span style="color:#ff0000">Long-term complicated of untreated UDT''' | * '''<span style="color:#ff0000">Long-term complicated of untreated UDT</span>''' | ||
*# '''<span style="color:#ff0000">Hypogonadism''' | *# '''<span style="color:#ff0000">Hypogonadism</span>''' | ||
*# '''<span style="color:#ff0000">Reduced fertility''' | *# '''<span style="color:#ff0000">Reduced fertility</span>''' | ||
*#* Sperm counts are reduced in > 25% of formerly unilateral and the majority of formerly bilateral cryptorchid men | *#* Sperm counts are reduced in > 25% of formerly unilateral and the majority of formerly bilateral cryptorchid men | ||
*#* '''Paternity rates are largely unchanged for men with unilateral cryptorchidism compared to the general population''' (≈90%), '''but are significantly lower (33‒65%) for those with bilateral UDT''' | *#* '''Paternity rates are largely unchanged for men with unilateral cryptorchidism compared to the general population''' (≈90%), '''but are significantly lower (33‒65%) for those with bilateral UDT''' | ||
*#* '''Both location and time of UDT correlate with Leydig and germ cell loss.''' | *#* '''Both location and time of UDT correlate with Leydig and germ cell loss.''' | ||
*#** '''Intra-abdominal/non-palpable testes depict severe germ cell loss, as do testes that remain undescended by age 2''' | *#** '''Intra-abdominal/non-palpable testes depict severe germ cell loss, as do testes that remain undescended by age 2''' | ||
*# '''<span style="color:#ff0000">Risk of testicular cancer''' | *# '''<span style="color:#ff0000">Risk of testicular cancer</span>''' | ||
*#* '''Relative risk (RR) of UDT: 2.75‒8x; risk is slightly increased also in the normally descended testis.''' | *#* '''Relative risk (RR) of UDT: 2.75‒8x; risk is slightly increased also in the normally descended testis.''' | ||
*#* '''Performing orchiopexy prior to puberty appears to decrease the RR of subsequent testicular cancer to 2.23, but it still remains above that of the normal non-cryptorchid male''' | *#* '''Performing orchiopexy prior to puberty appears to decrease the RR of subsequent testicular cancer to 2.23, but it still remains above that of the normal non-cryptorchid male''' | ||
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*#** '''Scrotal (treated) testis: non-seminoma more likely (63%)''' | *#** '''Scrotal (treated) testis: non-seminoma more likely (63%)''' | ||
*#* '''The risk of benign testicular tumours (e.g. mature teratoma) is not increased with cryptorchidism''' | *#* '''The risk of benign testicular tumours (e.g. mature teratoma) is not increased with cryptorchidism''' | ||
* '''Goals of treatment''' | * '''<span style="color:#ff0000">Goals of treatment</span>''' | ||
*# '''Maximize chances of adequate hormone production and future fertility potential''' by preventing acquired/progressive damage | *# '''<span style="color:#ff0000">Maximize chances of adequate hormone production and future fertility potential</span>''' by preventing acquired/progressive damage | ||
*# '''Prevent testicular torsion''' | *# '''<span style="color:#ff0000">Prevent testicular torsion</span>''' | ||
*# '''Locate testicle(s) in a position amenable to self-exam''' (or caretaker/healthcare provider regular assessment in patients unable to reliably conduct self-examination) which aids in early diagnosis of testicular cancer | *# '''<span style="color:#ff0000">Locate testicle(s) in a position amenable to self-exam</span>''' (or caretaker/healthcare provider regular assessment in patients unable to reliably conduct self-examination) which aids in early diagnosis of testicular cancer | ||
*# '''Treat associated conditions, such a patent processus vaginalis/inguinal hernia''' | *# '''<span style="color:#ff0000">Treat associated conditions, such a patent processus vaginalis/inguinal hernia</span>''' | ||
*# Avoid missing viable gonadal tissue in an abnormal location (most important intra-abdominal), as it could lead to delayed diagnosis of '''testicular neoplasm''' | *# Avoid missing viable gonadal tissue in an abnormal location (most important intra-abdominal), as it could lead to delayed diagnosis of '''testicular neoplasm''' | ||
*# Relocate all viable gonad(s) in scrotum to maximize '''psychological benefits of normal anatomy''' | *# Relocate all viable gonad(s) in scrotum to maximize '''psychological benefits of normal anatomy''' | ||
*# '''Prevent direct testicular trauma''' against the pelvic bones during intercourse or sports | *# '''<span style="color:#ff0000">Prevent direct testicular trauma</span>''' against the pelvic bones during intercourse or sports | ||
*# '''Avoid unnecessary imaging studies''' | *# '''Avoid unnecessary imaging studies''' | ||
*# '''Minimize parental anxiety''' | *# '''Minimize parental anxiety''' | ||